DRG付费方式下医患关系的价值冲突与动态治理

[关键词]DRG付费；医患关系；价值冲突；动态治理

[中图分类号]R-052 [文献标码]A [文章编号]1001-8565（2025）08-1022-07

DOI：10.12026/j. issn.1001-8565.2025.08.10

Valueconflicts and dynamic governance of doctor-patient relationships under the

DiagnosisRelatedGroupspaymentsystem

RENJinwen，ZHUJiaying，JIJianjun，LI Xia （Medical Insurance and Price Administration Office， Zhejiang Provincial People's Hospital/People' s Hospital ofHangzhouMedical College，Hangzhou 3lool4，China）

Abstract：With the fullimplementation of the Diagnosis Related Groups（DRG） payment model，its institutional advantages in optimizing resource allocation and controlling medical costs through fixed disease payment standards have gradually emerged.However，it has also triggered structural value conflicts in the doctor-patient relationship.Basedon the four principles of medical ethics，this paper constructed an analytical framework for the value conflicts in doctor-patient relationships under the DRG payment model. Starting from the manifestations of value conflicts，the inducements creating them were analyzed in depth. On these foundations，multi-dimensional optimization paths were proposed，including repairing respect-related conflicts through information transparency and decision-making co-governance;constructing a refined cost management system and embedding an ethical review mechanism to resolve non-harm conflicts；implementing a phased payment mechanism for innovative technologies and an ethical review exemption mechanism to alleviate benefit conflicts；as well as designing dynamic payment rules，unifying payment standards for insurance participation types，and strengthening dynamic monitoring to address justice conflicts.Under this framework，this paper aimed to promote the gradual transformation of DRG from a cost-control tool to a governance tool. While ensuring the securityofthefund，it was necessry to maintain thebotom line ofquality，stimulate technological innovation，and return to the patient-centered concept，thereby promoting the doctor-patient relationship to shift from a zero-sum game to a symbiotic and win-win situation.

Keywords： Diagnosis Related Groups payment； doctor-patient relationship；value conflict； dynamicgovernance

2021年《国家医疗保障局DRG/DIP支付方式改革三年行动计划》的颁布标志着中国医保支付模式从按项目付费向按病种打包付费的全面转型。（剩余10856字）